The Accelerating Collectivizing of American Medicine

During a hearing before the House Small Business Committee on Thursday, health-care professionals explained that the shift has already been picking up momentum in recent years, driven largely by growing regulatory and administrative burdens, rising malpractice costs and declining reimbursements from insurers -- all of which they say have hit small practices especially hard. Consequently, doctors are shying away from the traditional solo practitioner model in favor of employment at large hospitals...

Now there's an additional catalyst physicians say may expedite the decline of small practices -- the Patient Protection and Affordable Care Act, passed in 2010 and recently approved by the Supreme Court.

For starters, PPACA made Accountable Care Organizations -- referring to groups of providers that take responsibility for the care for an entire patient group -- an official part of the Medicare program this year, giving hospitals added incentive to scoop up physician partners.

"Because of bundled payments and other measures in the law, hospitals want to make sure they have enough primary care physicians, particularly, as well as specialists that they can have in their Accountable Care Organizations so they can participate," Dr. Jerry Kennett, senior partner at Missouri Cardiovascular Specialists in Columbia, Mo., told lawmakers.

But the law also comes with new regulations and non-compliance penalties that could further deter doctors from self-employment...

The Obama administration regards this collectivization of medical
providers as a desirable outcome, not merely some “unintended
consequence.”

As Obama health advisor Nancy-Ann DeParle wrote last year
in the Annals of Internal Medicine,
the new law will “accelerate physician employment by hospitals and
aggregation into larger physician groups” and “physicians will need to
embrace rather than resist change.”

Translation: “Doctors should get
with the program — or else!”

Furthermore, such collectivization is merely a continuation of a much older strategy.

Jonah Goldberg’s book Liberal Fascism
described how the Roosevelt administration sought similar
consolidations of American agriculture and business during the New Deal.
As Goldberg noted:

[If] you want to use business to implement your social
agenda, then you should want businesses themselves to be as big as
possible. What’s easier, strapping five thousand cats to a wagon or a
couple of giant oxen?

Similarly, it will be much easier for the federal government to regulate 100 large ACOs than 10,000 small private practices.

Once doctors are herded into ACOs, they will become increasingly
accustomed to simply following orders from ACO administrators (who in
turn will be proxies for government health bureaucrats).

The New York Times
recently reported that after physicians became hospital employees, they
became much more accepting of government controls over health care than
their counterparts in private practice...

If a physician freely decides to join a large multispecialty group practice (or become a hospital employee) based on his own best professional judgment and individual practice preferences, this is not necessarily bad.

But when the government tilts the playing field to drive doctors out of small private practices into these more easily-regulated large entities, that's a different matter altogether.

About FIRM

America was founded on the principles of freedom and individual rights. Applied to medicine, the law must respect the individual rights of doctors and other providers, allowing them the freedom to practice medicine. This includes the right to choose their patients, to determine the best treatment for their patients, and to bill their patients accordingly. In the same manner, the law must respect the individual rights of patients, allowing them the freedom to seek out the best doctors and treatment they can afford.

Freedom and Individual Rights in Medicine (FIRM) promotes the philosophy of individual rights, personal responsibility, and free market economics in health care. FIRM holds that the only moral and practical way to obtain medical care is that of individuals choosing and paying for their own medical care in a capitalist free market. Federal and state regulations and entitlements, we maintain, are the two most important factors in driving up medical costs. They have created the crisis we face today.

Freedom and Individual Rights in Medicine was founded by Lin Zinser and Paul Hsieh, MD in 2007. It is now managed by Paul Hsieh, MD.